Plans Highlights

$50,000, $100,000, $250,000 or $500,000 per illness or injury with a lifetime maximum of $5,000,000

DEDUCTIBLE

$0, $100, $250 or $500 per illness or injury available

COINSURANCE

Company pays 100%

Pre-Existing Conditions Coverage

Pre-existing Conditions?: For conditions existing within 36 months before effective date,charges excluded until after 12 months of coverage and then $500 maximum per period of coverage and $1,500 lifetime maximum Sudden and unexpected recurrence of a Pre-existing Conditions:

Eligible Medical Expenses: $5,000 lifetime maximum

Emergency medical evacuation: $25,000 maximum

Benefits Details

Benefits

Coverage

Hospital room and board

Up to average semi-private room rate

Intensive care unit

Company pays 100% after deductible is met

Physical therapy

Company pays 100% after deductible is met; one visit per day(Medical order or treatment plan required)

Bedside Visit

$1,500 maximum limit. Must be hospitalized in an intensive care unit. Not subject to deductible

Physician visit

Company pays 100% after deductible is met; one visit per day

Student health center

$5 co-pay per visit (Not subject to deductible)

Prescription drugs

Company pays 100% after deductible is met
90 day dispensing maximum

Urgent care

$50 copay. Not subject to deductible.
Copay is not applicable if you choose a $0 deductible

walk-in clinic

$20 copay. Not subject to deductible.
Copay is not applicable if you choose a $0 deductible

Eligible medical expenses

Company pays 100% after deductible is met

Emergency room visit with in-patient admission

Company pays 100% after deductible is met

Emergency room visit without in-patient admission

Additional $250 deductible

Interfacility ambulance transfer(for services rendered in the U.S.)

Company pays 100%. Transfer must be a result of an inpatient hospital admission not subject to deductible